scholarly journals Modeling Emergency Department crowding: Restoring the balance between demand for and supply of emergency medicine

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0244097
Author(s):  
John Pastor Ansah ◽  
Salman Ahmad ◽  
Lin Hui Lee ◽  
Yuzeng Shen ◽  
Marcus Eng Hock Ong ◽  
...  
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
Emergency Medicine ◽  
Primary Care Clinic ◽  
Public Hospitals ◽  
Care Clinic ◽  
Care Services ◽  
Primary Care Services ◽  
Number Of Patients ◽  
Ed Crowding

Emergency Departments (EDs) worldwide are confronted with rising patient volumes causing significant strains on both Emergency Medicine and entire healthcare systems. Consequently, many EDs are in a situation where the number of patients in the ED is temporarily beyond the capacity for which the ED is designed and resourced to manage―a phenomenon called Emergency Department (ED) crowding. ED crowding can impair the quality of care delivered to patients and lead to longer patient waiting times for ED doctor’s consult (time to provider) and admission to the hospital ward. In Singapore, total ED attendance at public hospitals has grown significantly, that is, roughly 5.57% per year between 2005 and 2016 and, therefore, emergency physicians have to cope with patient volumes above the safe workload. The purpose of this study is to create a virtual ED that closely maps the processes of a hospital-based ED in Singapore using system dynamics, that is, a computer simulation method, in order to visualize, simulate, and improve patient flows within the ED. Based on the simulation model (virtual ED), we analyze four policies: (i) co-location of primary care services within the ED, (ii) increase in the capacity of doctors, (iii) a more efficient patient transfer to inpatient hospital wards, and (iv) a combination of policies (i) to (iii). Among the tested policies, the co-location of primary care services has the largest impact on patients’ average length of stay (ALOS) in the ED. This implies that decanting non-emergency lower acuity patients from the ED to an adjacent primary care clinic significantly relieves the burden on ED operations. Generally, in Singapore, there is a tendency to strengthen primary care and to educate patients to see their general practitioners first in case of non-life threatening, acute illness.

scholarly journals Evaluation of the Integrated Primary Care Clinic Into Behavioral Care Setting

2018 ◽  
Vol 10 (11) ◽  
pp. 169
Author(s):  
Jarman Alqahtani ◽  
Daniel West
Keyword(s):  
Primary Care ◽  
Care Setting ◽  
Primary Care Clinic ◽  
Behavioral Health Care ◽  
Patient Survey ◽  
Care Clinic ◽  
New Model ◽  
Care Services ◽  
Primary Care Services ◽  
Short Period

OBJECTIVE: The study has aimed to explore the process, outcomes of primary care, and barriers that make the primary care access difficult for the patients. DESIGN & SETTING: The study has utilized quantitative and qualitative approach and collected data from the clinic and patients. Patient survey was conducted to ask the patients about the possible reasons, which prevent them from accessing primary care services in the past. RESULTS: The mean age of patients was 46 years, among which majority (65%) were males. The results showed that education was the significant factor in determining the health status of a specific population. The clinic was successfully integrated into the behavioral health care setting. Many patients had been enrolled in the clinic for the first time with the help of a care manager that facilitated the identification of those patients. Most commonly, transportation was the main barrier for those populations for not seeking the primary care services. Emergency department use significantly declined after the implementation of the new model that reduced the cost of health services dramatically in a short period of time i.e. 6 months. CONCLUSION: There are susceptical gaps within the fragmented care due to high rates of physical health conditions. Majority of the patients in the study sample were satisfied with the new model; therefore, the new model was termed as effective and efficient.

Use of Health Care Services by Inner-city Infants in an Early Discharge Program

PEDIATRICS ◽  
1996 ◽  
Vol 98 (4) ◽  
pp. 686-691
Author(s):  
William O. Cooper ◽  
Uma R. Kotagal ◽  
Harry D. Atherton ◽  
Carrie A. Lippert ◽  
Elizabeth Bragg ◽  
...  
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
Inner City ◽  
Primary Care Clinic ◽  
Early Discharge ◽  
Emergency Department Visits ◽  
Care Clinic ◽  
Children's Hospital ◽  
Care Services ◽  
Children’S Hospital

Objective. To assess the use of health care services by inner-city infants enrolled in an early discharge program who received care in a tertiary care children's hospital primary care clinic. Design. Retrospective cohort study. Setting. Large, metropolitan university hospital and a children's hospital. Patients. Term infants cared for in a single full-term nursery, before and after implementation of a coordinated early discharge program, who received primary care at the children's hospital. Intervention. The coordinated Early Discharge Program was characterized by in-hospital visits by hospitalbased coordinating nurses, home visits by nurses from a home nursing agency, and communication with physicians for necessary adjustments in postdischarge care. Methods. After linking birth hospital records and the children's hospital medical records, a retrospective chart review was performed to obtain maternal demographic information and birth hospital length of stay, as well as the infants' attendance at primary care clinic, immunizations, emergency department visits, and rehospitalization. Main Outcome Measures. Number of primary care visits in the first 3 months of life, completion of one series of immunizations by 3 months of life, and number of emergency department visits and rehospitalization during the first 3 months of life. Results. The early discharge group (n = 253) had a significantly shorter birth hospital length of stay (35 ± 24 hours, mean ± SD) when compared with the control group (n = 212) (52 ± 14 hours). The early discharge group was also younger than the control group at the first primary care visit, with significantly more infants visiting the primary care clinic in the first month of life. There was also a significant difference between the groups in the mean number of emergency department visits (early discharge = .61 visits/patient, control = .79 visits/patient) and the proportion of patients with no emergency department visits during the first 3 months of life (early discharge = 57%, control = 43%). There was no difference between the two groups in the proportion of infants completing one series of immunizations or in the number of infants rehospitalized during the study period. Conclusions. Coordinated early discharge with home nursing visits for inner-city infants may result in earlier use of primary care services. Furthermore, there is a significant decrease in use of the emergency department during the first 3 months of life, and no increase in rehospitalization.

A Previsit Screening Checklist Improves Teamwork and Access to Preventive Services in a Medical Home Serving Low-Income Adolescent and Young Adult Patients

2017 ◽  
Vol 57 (7) ◽  
pp. 835-843
Author(s):  
Sophie H. Allende-Richter ◽  
Sydney T. Johnson ◽  
Mariam Maloyan ◽  
Patricia Glidden ◽  
Kerrilynn Rice ◽  
...  
Keyword(s):  
Primary Care ◽  
Young Adults ◽  
Low Income ◽  
Primary Care Clinic ◽  
Team Work ◽  
Adolescents And Young Adults ◽  
Care Clinic ◽  
Care Services ◽  
Primary Care Services ◽  
Publicly Insured

Publicly insured adolescents and young adults experience significant obstacles in accessing primary care services. As a result, they often present to their medical appointments with multiple unmet needs, adding time and complexity to the visit. The goal of this project was to optimize team work and access to primary care services among publicly insured adolescents and young adults attending an urban primary care clinic, using a previsit screening checklist to identify patient needs and delegate tasks within a care team to coordinate access to health services at the time of the visit. We conducted an interventional quality improvement initiative in a PDSA (Plan-Do-Study-Act) cycle format; 291 patients, 13 to 25 years old were included in the study over an 8-months period. The majority of patients were receptive to the previsit screening checklist; 85% of services requested were provided; nonclinician staff felt more involved in patient care; and providers’ satisfaction increased.

scholarly journals 140. Symptoms and Situations Predispose Patients to Use Antibiotics Without Medical Advice

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S200-S200
Author(s):  
Michael Hansen ◽  
Barbara Trautner ◽  
Roger Zoorob ◽  
George Germanos ◽  
Osvaldo Alquicira ◽  
...  
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
Emergency Departments ◽  
Primary Care Clinic ◽  
Antibiotic Use ◽  
Safety Net ◽  
Care Clinic ◽  
Primary Care Clinics ◽  
Primary Care Patients ◽  
Emergency Department Patients

Abstract Background Use of antibiotics without a prescription (non-prescription use) contributes to antimicrobial resistance. Non-prescription use includes obtaining and taking antibiotics without a prescription, taking another person’s antibiotics, or taking one’s own stored antibiotics. We conducted a quantitative survey focusing on the factors that impact patients’ decisions to use non-prescription antibiotics. Methods We surveyed patients visiting public safety net primary care clinics and private emergency departments in a racially/ethnically diverse urban area. Surveys were read aloud to patients in Spanish and English. Survey domains included patients’ perspectives on which syndromes require antibiotic treatment, their perceptions of health care, and their access to antibiotics without a prescription. Results We interviewed 190 patients, 122 from emergency departments (64%), and 68 from primary care clinics (36%). Overall, 44% reported non-prescription antibiotic use within the past 12 months. Non-prescription use was higher among primary care clinic patients (63%) than the emergency department patients (39%, p = 0.002). The majority felt that antibiotics would be needed for bronchitis (78%) while few felt antibiotics would be needed for diarrhea (30%) (Figure 1). The most common situation identified “in which respondents would consider taking antibiotics without contacting a healthcare provider was “got better by taking this antibiotic before” (Figure 2). Primary care patients were more likely to obtain antibiotics without prescription from another country than emergency department patients (27% vs. 13%, P=0.03). Also, primary care patients were more likely to report obstacles to seeking a doctor’s care, such as the inability to take time off from work or transportation difficulties, but these comparisons were not statistically significant. Figure 1. Patients’ agreement that antibiotics would be needed varied by symptom/syndrome. Figure 2. Situations that lead to non-prescription antibiotic use impacted the two clinical populations differently Conclusion Non-prescription antibiotic use is a widespread problem in the two very different healthcare systems we included in this study, although factors underlying this practice differ by patient population. Better understanding of the factors driving non-prescription antibiotic use is essential to designing patient-focused interventions to decrease this unsafe practice. Disclosures All Authors: No reported disclosures

Presentation to Either the Pediatric Emergency Department or Primary Care Clinic for Acute Illness

2014 ◽  
Vol 30 (3) ◽  
pp. 146-150 ◽  
Author(s):  
Natalie Nokoff ◽  
Andrew M. Brunner ◽  
James G. Linakis ◽  
Siraj Amanullah
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
Primary Care Clinic ◽  
Pediatric Emergency ◽  
Acute Illness ◽  
Pediatric Emergency Department ◽  
Care Clinic

scholarly journals Feasibility and Acceptability of a Colocated Homeless-Tailored Primary Care Clinic and Emergency Department

2017 ◽  
Vol 8 (4) ◽  
pp. 338-344 ◽  
Author(s):  
Sonya Gabrielian ◽  
Jennifer C. Chen ◽  
Beena P. Minhaj ◽  
Rishi Manchanda ◽  
Lisa Altman ◽  
...  
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
Primary Care Clinic ◽  
Care Clinic

scholarly journals The impact of general practitioners working in or alongside emergency departments: a rapid realist review

BMJ Open ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. e024501 ◽  
Author(s):  
Alison Cooper ◽  
Freya Davies ◽  
Michelle Edwards ◽  
Pippa Anderson ◽  
Andrew Carson-Stevens ◽  
...  
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
General Practitioners ◽  
Patient Experience ◽  
Emergency Departments ◽  
Care Facility ◽  
Patient Choice ◽  
Care Services ◽  
Primary Care Services ◽  
The Impact

ObjectivesWorldwide, emergency healthcare systems are under intense pressure from ever-increasing demand and evidence is urgently needed to understand how this can be safely managed. An estimated 10%–43% of emergency department patients could be treated by primary care services. In England, this has led to a policy proposal and £100 million of funding (US$130 million), for emergency departments to stream appropriate patients to a co-located primary care facility so they are ‘free to care for the sickest patients’. However, the research evidence to support this initiative is weak.DesignRapid realist literature review.SettingEmergency departments.Inclusion criteriaArticles describing general practitioners working in or alongside emergency departments.AimTo develop context-specific theories that explain how and why general practitioners working in or alongside emergency departments affect: patient flow; patient experience; patient safety and the wider healthcare system.ResultsNinety-six articles contributed data to theory development sourced from earlier systematic reviews, updated database searches (Medline, Embase, CINAHL, Cochrane DSR & CRCT, DARE, HTA Database, BSC, PsycINFO and SCOPUS) and citation tracking. We developed theories to explain: how staff interpret the streaming system; different roles general practitioners adopt in the emergency department setting (traditional, extended, gatekeeper or emergency clinician) and how these factors influence patient (experience and safety) and organisational (demand and cost-effectiveness) outcomes.ConclusionsMultiple factors influence the effectiveness of emergency department streaming to general practitioners; caution is needed in embedding the policy until further research and evaluation are available. Service models that encourage the traditional general practitioner approach may have shorter process times for non-urgent patients; however, there is little evidence that this frees up emergency department staff to care for the sickest patients. Distinct primary care services offering increased patient choice may result in provider-induced demand. Economic evaluation and safety requires further research.PROSPERO registration numberCRD42017069741.

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